Basic Information
| Provider Information | |||||||||
| NPI: | 1285982710 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEHAB | ||||||||
| FirstName: | MORAY | ||||||||
| MiddleName: | JAMIL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 PARKLANE BLVD STE 695 | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481262776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132718170 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6 PARKLANE BLVD | ||||||||
| Address2: | SUITE 695 | ||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481262696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132718170 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2012 | ||||||||
| LastUpdateDate: | 08/15/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801088785 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.